| NPI | 1194109157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 76491) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 060627) |
| Enumeration Date | 2015-07-18 |
| Last Update Date | 2026-05-07 |